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Clinical evidence of the efficacy of balloon angioplasty with stenting vs. angioplasty alone, and drug-eluting vs. bare-metal stenting in the prevention of re-stenosis in patients with coronary artery disease

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Abstract

The risk of developing coronary artery disease for both men and women is increasing in society today. While previous cardiovascular research emphasized only hypertension and hyperlipidemia, the importance of treating the inflammation process is becoming understood. Over the past twenty-five years, the concepts of PTCA and stenting have become dominant modalities in the treatment of CAD. In the late 1970’s and early 1980’s, PTCA was seen as the best possible alternative to bypass surgery until repetitive treatments were required to reopen occluded arteries. Following the failure of PTCA, stenting and derivatives of stenting with drug-eluting compounds have been developed to examine the most effective revascularization technique to reduce the rate at which re-stenosis occurs.
Methodology: The purpose of this study was to perform a systematic examination of the literature to evaluate these techniques. Articles included in the review involved randomized controlled clinical trials of adults from 50-75 years of age who had undergone either angioplasty or stenting from the years 1979 to 2006. Terms the research included were coronary artery disease, balloon angioplasty, stenting, atherosclerosis, drug-eluting stents, and re-stenosis.
Results: Thirty-seven articles met inclusion criteria and were reviewed for accuracy and applicability. Following an analysis of the articles, the overwhelming consensus was that the use of balloon angioplasty with stenting is more effective than angioplasty alone, and insufficient evidence is available to determine whether drug-eluting stenting is more effective than bare-metal stenting in the prevention of restenosis in patients with CAD.
Conclusion: The most effective treatment for patients with CAD is balloon angioplasty with stenting with insufficient evidence as to the type of stent most appropriate due to potential side-effects of both types of stents.

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A project presented to the Department of Physician Assistant of Wichita State University in partial fulfillment of the requirements for the degree of Master of Physician Assistant.